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Why is one side of my big toe nail thick and the other side thin, and what should I do about it?

May 27, 2023 Source: Cainiu Health
Dr. Liu Wan
Introduction
Thickening on one side of the big toenail and thinning on the other may be caused by improper trimming, nail dystrophy, paronychia, onychomycosis, psoriasis, or other conditions, and treatment should be selected based on the specific diagnosis. Improper nail trimming can injure the nail or the surrounding skin, potentially leading to uneven nail shape, with one side cut too deeply or unevenly.

Under normal circumstances, uneven thickness of the toenail on one side of the big toe—thicker on one side and thinner on the other—may be caused by improper nail trimming, nail dystrophy, paronychia, onychomycosis, or psoriasis. Treatment depends on the specific condition. The details are as follows:

1. Improper Trimming

Improper nail trimming may injure the nail or surrounding skin. Such injury can lead to irregular nail shape; one side may have been cut too deeply or unevenly, causing it to become thinner, while the other side remains unaffected and thus stays thicker.

2. Nail Dystrophy

Long-term irregular eating habits or picky eating may lead to malnutrition, affecting the nutrient supply to the nails and resulting in abnormal nail growth. Multivitamin tablets or compound vitamin tablets may be taken under medical guidance.

3. Paronychia

Paronychia is an infectious skin condition occurring around the nail, commonly at the junction between the nail and surrounding skin, especially in the big toe. During an episode, infection causes swelling, redness, and pain in the surrounding tissue, potentially disrupting nail growth. This may result in thickening and deformation on one side of the nail, while the other side becomes thinner due to infection or injury. Treatment may include fusidic acid sodium cream or minocycline hydrochloride capsules under a doctor's supervision.

4. Onychomycosis (Nail Fungus)

This condition is usually caused by dermatophytes or other bacteria invading the nail plate or tissue beneath it. After invasion, the pathogen increases keratin accumulation, leading to thickening of one part of the nail. Treatments such as miconazole nitrate cream or coral fungus tincture may be used as directed by a physician.

5. Psoriasis

Psoriasis occurs when the immune system mistakenly accelerates skin cell growth. In the nail bed, this can cause uneven nail growth—some areas may become excessively thickened, while others remain relatively thin. Topical treatments such as calcipotriol ointment or tacalcitol ointment may be used under medical supervision.

If any discomfort or symptoms occur, prompt medical consultation is recommended to avoid delaying treatment.

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